Inga Lennes, MD, MBA, MPH: The Patient as Your North Star
Episode #51 of the Charged podcast
PodcastFeb | 17 | 2021
Uma Naidoo, MD, developed a passion for food and cooking at a young age—a deep interest that persisted throughout her career as a practicing psychiatrist. Eventually, it led her to wonder if food and diet can somehow be used in mental health medicine. As the founder and director of the Nutritional and Lifestyle Psychiatry Program at Mass General, Dr. Naidoo is a leading expert and pioneer in the field of nutritional psychiatry, a new area of research and clinical practice that looks at how food influences brain function.
In this episode of Charged, Dr. Naidoo talks to us about how she built her career in this niche, how she helps patients foster healthy diets to improve their mental health and her experience implementing this knowledge in her own life.
Uma Naidoo, MD, is the director of Nutritional and Lifestyle Psychiatry at Mass General and a faculty member at Harvard Medical School as well as a professional chef and nutrition specialist.
In her role as a clinical scientist, Dr. Naidoo founded and directs the first hospital-based clinical service in Nutritional Psychiatry in the U.S. In addition to her work as a psychiatrist, Dr. Naidoo is interested in the impact of food on mood and other mental health conditions.
Dr. Naidoo graduated from the Harvard-Longwood Psychiatry Residency Training Program in Boston where she was the first psychiatrist to be awarded the “Curtis Prout Scholar in Medical Education.”
After pursuing her passion in cooking by completing both savory and pastry classes at Le Cordon Bleu in Paris and at the Culinary Institute of America, Dr. Naidoo decided to pursue a degree as a professional chef from the Cambridge School of Culinary Arts in Massachusetts.
Dr. Naidoo is also the author of This Is Your Brain On Food, which was released in 2020.
Q: Dr. Uma Naidoo learned, at a young age, the influence that food can have on mental health. Having grown up in a large family in South Africa that cooked together, Uma recalls many happy moments spent in the kitchen and at the dinner table. During her early days as a practicing psychiatrist, Uma spent a lot of her spare time developing her cooking skills. This passion led her on the path of becoming both a certified chef and nutrition specialist.
And it was during this time that she became inspired by a new curiosity. Can gut health and brain health be thought of together? And if so, can food be used in mental health medicine? As the founder and director of the Nutritional and Lifestyle Psychiatry Program at Mass General, Uma is a leading expert and pioneer in the field of nutritional psychiatry, a new area of research and clinical practice that looks at how food influences brain function.
In her work, Uma helps her patients foster healthy diets to improve their mental health, and conducts research to raise awareness about this emerging area of care. So welcome, Uma.
A: Thank you so much, Kelsey. I appreciate being here.
Q: So I think probably many listeners can relate to, at one point or another, that influence that food can have on the mood. And I'm really excited to dig into that. But before we get there, I'm wondering if you might talk a little bit about how your own relationship with food and cooking really began.
A: As you alluded to, it began in my childhood, growing up in a very large Indian family, where there were many cooks in the kitchen. And I wasn't necessarily expected to cook, except hang around and observe and learn. And I enjoyed that very much. So it was always a spirit of warmth and love and nurturance, but also paying attention to healthy eating. I grew up in a very large family of physicians who were both allopathic medical doctors, and a few ayurvedic practitioners.
So there was this focus on holistic health, how we ate, but also the joy of being around food in a healthy way.
But, as I delved deeper into it, I realized that food could have many, many different impacts. And it really was brought to life as a very young student, I was, you know, learning how to prescribe medications. And the patient accused me of causing him to gain weight only two weeks after he started the medication.
And I knew, from my notes, that I had not caused the weight gain, and neither had the medication. I knew that quite well. But I listened to what he had to say. It's a little scary when you're very junior in your career, to have someone be upset with you.
But, as I spoke to him, I looked at what he held in his hand. And it was one of those very large, very famous in Boston, Dunkin Donuts coffees, you know, the 20 ounce size. And I immediately thought to myself, well, I wonder what he's putting in his coffee. And I asked him that. And you know, Kelsey, thinking back, that was a very seminal moment in how I began to think more deeply about that connection with food, nutrition, nutrients, and really mental health.
Because he had been prescribed a medication which technically could have caused weight gain. And he was being treated for depression. But at the same time, when we broke it down, and we looked into what he was adding to his coffee, he was adding a processed creamer, which is probably more than a quarter cup, and then about eight teaspoons of sugar.
And the fact that I was able to interpret that back, and I could see something switch in his response to understanding.
I felt that that was a powerful tool, to start explaining things to patients. And I began to really follow and explore down that path.
Q: So I'm intrigued to hear more about sort of what the conversation was like with your family in the kitchen at the dining room table. You said that they were physicians as well. And ayurvedic eating was part of your growing up. So do you recall conversations with your family members about this topic as a child?
A: I do. You know, I might have mentioned to you that, instead of going to preschool, nursery school, I actually hung out with my grandmother. Apparently, this was my choice. And she was just a very nurturing and loving person. And so much so, that I dedicated my new book to her.
And so, during the day, I would hang out with my grandmother. And she would pick fresh vegetables in the garden. And she would be preparing lunch for my grandfather and myself. And you know, there was just this experience around food that was healthy and natural. And I so appreciated having exposure to that.
And then there would be the family dinners that we'd have. And, you know, since there were so many physicians, some of my mom's siblings were also medical residents at the time. So there would be talk around what they might have been telling their patients, and what food is healthy, and what food is not. And then, you know, there would be the family members who were practicing ayurvedic medicine, talking about, you know, different ingredients, and the types of food.
What I took away, I think, was really a holistic model of care. Meaning that you don't just look at medical care or health through one lens. That there's mindfulness. There's meditation. I learned to meditate as a child. So, you know, that was sort of something I just grew up around. Yoga was part of the practice as well.
I began studying later in mental health with all of this as part of myself. And I didn't realize that those could be very effective tools to help my patients, until that particular patient who challenged me. And I really then began to use those tools in an actionable way, with individuals that I was seeing.
Q: So I'm sure your grandmother loved having you in the garden and spending so much time with you. And you had also mentioned your mother, and when you came to the United States, bringing her recipes with you, as sort of maybe a source for comfort. And I think the first thing I think about, maybe other people feel the same way, is the term “comfort food,” so foods that kind of make you feel better, make you feel warmer, that kind of thing. Did you find that to be true with some of the recipes that you were bringing over and cooking for yourself?
A: I feel like the comfort for me came from that connection. It came from the comfort of knowing that I had the spices, or that I knew her spice blends. And that brought me closer to home. And the other thing was the connection to those memories, and the sense of nutrients I grew up around, were also important to me.
And I think that they helped me. They helped bolster, you know, those lonely dark days in Boston, when you only see snow, and it's kind of dark hours. And having grown up in quite a tropical climate, that was also true. So food and that meant many different things.
And I say that, Kelsey, because you know, comfort foods in nutritional psychiatry, it's such a challenging word, because the truth is that comfort foods really create discomfort in the brain, in terms of our mental well being So it's sort of about changing that conversation, about how we nurture ourselves, and maybe find healthier paths, for how we eat.
Q: Sure. Revisiting that first patient that you had, where you experienced sort of that backlash, where did that fall in your training with combining psychiatry with nutritional science?
And that caused me to delve deeper each time, and to ask more questions about what someone was eating.
If they were starting medication, and knew that some of these medications had devastating side effects, I wanted to know, well what are you doing for exercise? And asking, in especially mental health, in a non-judgmental way. And the reason being that when someone's, you know, severely depressed, they may not be able to get out of bed. So asking, can you get the newspaper tomorrow? You know, do you walk the dog? Can you go get a morning cup of coffee during the day? Just in other words, you're asking are they moving, are they getting around, became important.
And then, what were you eating? What do you like to eat? Are there healthy swaps for this? Do you practice any mindfulness? Some of those components didn't come naturally.
I think what I feel very grateful for, is it grew in a very organic way, from natural and very meaningful interest that I had. And a way that I wanted to approach medical care patients, that it didn't have to be one dimension. It didn't just have to be the power of that prescription pad.
But I felt there had to be more. And that that part had to evolve. The individual having some autonomy. And also, some empowerment over choices they could make. Food was one of those realms, you know. The ability to exercise was another. Paying attention to sleep hygiene [?] because the plan of care, and the model of care that I use in my work is really a very holistic and integral approach to psychiatry.
A: It basically happened in the beginning with that patient. Because when I realized the power of interpreting back scientific information to a patient, even in simple terms such as, “This is how much you should be taking in. This is how many teaspoons. And this is how many grams of sugar. And that's what it means,” became very powerful, because he could understand it.
Q: And I'm really curious to know about sort of your transition to discovering this in your clinical practice. Did you go and get subsequent training once you sort of realized this initial connection and interest?
A: I did. So, you know, part of it was you go through psychiatry residency. I began to read as much research as I could get my hands on.
But my trip to culinary school was really an act of following a passion. I wanted to learn more about food. And Julia Child was my food hero. Because back to those early days in Boston, she would be, you know, on public television. And, you know, when you're studying, you can't really afford cable.
And she would be tossing omelets, and dropping things, and would be so charming and share such great knowledge, that I began working on some of her recipes. And I felt more confident. I felt like, you know, if I might be able to retry one of my mom's recipe.
When I learned that she had done this late in her career, in fact it was [00:17:36] Why can't I go and try culinary school? And it was a very meaningful time in learning. And now, when I think back, it was very hard. And I must have loved it, because I worked many, many hours to accomplish all of that.
So all to say that these different aspects between nutrition and culinary school, and really practicing psychiatry, came together in a very organic way, without planning, following things that I really loved doing. And as the field of nutritional mental health emerged, I began to put words to the work I was doing, and had been practicing.
And, you know, a great mentor of mine said to me one day, “Well, you do all of these components. Why don't you put it together? Because you're talking to me about this. And you know how to discuss a recipe. You can potentially even teach someone how to cook a recipe. So yeah, I think this really belongs, think more deeply about what you can do with it.” And that really brought forth the idea of founding the clinic that I run, and really enjoy doing.
It's small, and it's growing organically. But it's very specific niche work around nutritional mental health. And that's really how my work in nutritional psychiatry was born.
Q: Was there a precedent at that time for nutritional psychiatry? Was this something that people were kind of discovering this when you entered it? What was the history of it?
A: The history of it was that, for many years, including, you know, my mentors at Mass General have actually studied many of the nutrients and done the seminal studies in, say, methylfolate or vitamin D or magnesium omega-3 fatty acids. If you think about how we eat a meal. We don't usually just eat one nutrient and one ingredient, we eat a composed plate of food.
Well, in a similar way, over the last decade or so, two things happened. The integration of those different nutrients began to grew together in research that has been done. But also, the gut microbiome research has been burgeoning. And so the connection between the gut and the brain began to be much more significant. And the research has moved forward.
And when you put together how we eat, and the fact that we speak about an emotional feeling, but we don't connect it to our brain, that was, I guess, the gap that was missing. And what I really did spend time doing, was exploring the research around the gut microbiome, and putting together the studies that actually support how we eat, and this impacting our emotional health.
And that's really what I did for my book called This is Your Brain on Food. And that brought it forward in a much more real way.
And while nutritional psychiatry is a nascent field, the connection between food and the gut was, you know, outlined by Hippocrates. So I think that right now, we are bringing it forward, and trying to understand what we can do differently, in terms of our brain, you know, and our brain food, how it impacts our gut, and really, how ultimately it impacts our mental well being
Q: And you had mentioned some sort of gaps in understanding when it comes to the connection between food, the microbiome, and the brain have. Can you talk a little bit more about what those gaps are?
A: Sure. So, you know, any individual that you speak to has certain types of conversations with their doctors. And they might talk about a family history of diabetes, or you know, having gained a few pounds, or how should they eat differently for an elevated cholesterol level. But no one is really talking about the connection between the brain and how they eat and emotional health.
The brain is the most important organ. Because without the brain and how it functions, the rest of our bodies cannot function. So I really felt that this was a huge gap in the conversation. And while people may make a very clichéd statement, “Oh, I eat this and I feel terrible, or I eat this and I feel great,” no one was having the conversation around what the research was involved, whether this was true or not, is it true to have a gut feeling? You know, what does it actually mean?
And I really loved learning more about the gut microbiome. And I know that as medical doctors, we just don't learn enough about nutrition in medical school. So I felt like, if I wanted to understand this better, and serve my patients better, then I needed to learn better. So I felt like those things came forward. And the gaps beyond just the missing parts of the conversation, well also the fact that people don't understand the gut and the brain originate in the embryo from the same cells of the body.
And these all separate out, and they end up, you know, in the area of the gut and the brain. And then they connected throughout life by the vagus nerve, which is the 10th cranial nerve. And this nerve acts like a two-way super highway of chemical messages, 24/7. And so there's this ongoing communication that is bidirectional.
And then people know about medications such as Prozac or Zoloft, which are selective serotonin reuptake inhibitors. But more than 90 percent of the serotonin receptors are in the gut. So when you put that together, as well as the fact that right now, it's important to know that a very large component of our immune system is also the gut. So eating healthy for gut immunity, eating better for better mental well being, becomes hugely important.
Because, as you digest your food, the food is in that environment. And the breakdown of food, the products that get formed by the bacteria, there are 39 trillion bacteria that live in our gut. And they're not just bacteria. There are about five different types of organisms. They have significant impact on how that food is broken down.
But the type of food we eat is also impacted. So we can choose to, say, eat fast foods all the time, and junk foods, and processed foods, or we can choose a healthier diet. What we eat is going to impact those gut microbes. And they can either start to function for us, if we eat a healthier diet, or they can work against us, and start to set up conditions such as inflammation.
So these connections are much more real than we've understood before. And the research is also showing that they exist. And that we know we should be paying greater attention to how we eat, the impact on the microbiome, the impact on the microbes, et cetera.
Q: And I'm sure that it can be quite relative, depending on the patient that you're treating, or the condition that they're managing. But are there staple foods or ingredients that contribute to better mental health?
A: You know, there was a way that I organized information through looking at the research is really through groups of foods that, where there's an overarching sort of pillars of nutritional psychiatry that I call them, which are some healthy habits that everyone can achieve, and will really help the connection between the gut and the brain, by taking care of those gut bacteria, through how you eat.
So some of those simple things are really adding fiber to your diet through vegetables, fruit, low glycemic fruit like berries, beans, nuts, seeds, legumes, healthy whole grains, because you can only get fiber from those types of foods. You can't get fiber from animals, your food proteins. But adding fiber to your gut, and adding diversity of foods to your gut, you nurture those gut bacteria. And then those gut bacteria and gut microbes actually work to your better health.
So a simple way to think about it is, a happy gut is a happy mood. That's a very simplistic way to say it. But the truth is that, when you take care of those gut microbes, ultimately, your mood is going to be better, because you're not going to have the setup of inflammation.
Another is, you know, things like eat the rainbow of colors. The rainbow of colors really refers to anti-inflammatory, antioxidant rich foods, which are rich in different polyphenols. Think about the colors of a carrot, or a red pepper. And the more colors, the better. All of those nutrients, too many to count in a single salad, or a single plate of food, are entering your body and helping your gut microbiome, but also helping you with the nutrients that they're bringing back.
For example, so many of us may be lacking magnesium. Magnesium is very important mineral for both the management of depression and anxiety. And you know, red bell peppers are extremely rich in vitamin C. So that's another pillar. Then, explaining to people that prebiotic and probiotic foods are important, or fermented foods, you know.
And then there's specific foods for different conditions. Both foods to embrace and foods to avoid. For example, it's important to understand that refined and added sugars, you know, we may think of that as, oh, this is unhealthy. And I may gain a few pounds. But it's much more serious than that, in terms of the brain. Because refined and added sugars worsen depression, worsen anxiety and several other conditions, are indicated in ADHD, and you know, issues with focus and concentration.
So it becomes much more important when you dive deeper into the actual other types of foods and things to avoid, as well as those to embrace.
Q: That was going to be my next question, actually. And you touched on it a little bit. But I guess, on the flip side, you know, in addition to what you've already listed, are there sort of staple foods that people should be avoiding across the board?
A: It's really being aware of the standard American diet, and moving slowly away from that. If that's sort of what you're eating, then, you know, try to make healthy habit [00:29:00] within that. Because the standard American diet really consists of a lot of processed and ultra processed foods, a lot of junk foods, fast foods. Fast foods are often fried in processed vegetable oils. And processed vegetable oils worsen sometimes our mental well being
Transfats, actually will show up to behavioral aggression [?]. So, you know, processed foods, all processed junk foods, increased transfats, fast foods, and then the added refined sugars as well as artificial sweeteners, are some big categories of food ingredients.
And because of the gut microbiome, it becomes much more personalized, in terms of what someone may need to do, you know. For example
Even though fermented foods are healthy for many of us, they're not the healthiest foods for certain individuals with some histamine intolerances. So you have to be really careful and personalize the plan for the individuals whom you're seeing.
Q: So do you find that some patients come with sort of preconceptions about what might be causing symptoms in their—or triggering certain mental health conditions? Do you find that you have to unravel some of that? Or do they come as a blank slate? How does that work?
A: You know, because of how food is portrayed in the media, and in fad diets, what people see on the news, what they read in a popular magazine, what I find is, and what this was a very big reason for me to sort of put my thoughts down and complete the research in my book, was that people are confused. They don't know why they should eat blueberries. They know it's an antioxidant, but they're wondering, well, they tell me to eat it. Should I just eat a pound a day?
And that's why I think just understanding what their need is, and helping debunk certain things, and helping them understand why certain foods are important, certain foods are working against them, becomes very powerful information for them, because it is also empowering for them.
There's much more they can understand if you explain to them why the biodiversity of those different nutrients are important. Why their gut bacteria are affected by, say, leafy greens. Why certain nutrients in leafy greens can actually help with cravings. So eating a salad can be more meaningful for someone who is trying to lose a few pounds, because they understand the benefits of doing this, as well as the nutritional value. And I think that that becomes really very empowering to individuals.
Q: I'm also curious, too, how helping people shape their diets, how does sort of addiction to certain foods come into play? Do you find that it takes time for people who have quite a bit of sugar already in their diet to sort of wean themselves off of that? What's the approach to that?
A: It's also a steady approach for a few different reasons. It's very hard for people to make sudden changes, and make them all at once. And when they do that, they tend to fail. Or they sustain it for a few weeks, and then there's a boomerang effect. So it's much easier to work with them on a plan that makes sense, that is achievable, and that they're able to, you know, maybe make a few healthy habit changes at one time.
And then be able to practice that for a few weeks, and add more healthy habit changes on, rather than take on 10 things that they can do, and not be able to sustain it. And that becomes really important. And also, engaging the individual in a conversation around, “What do you think you can start with?” Because if they can choose, let's say, three things that they can do, then.
They buy into it, you know. They feel involved in making that decision, rather than the power of their prescription pad. Which, while it's important, someone feels, well they have to do that. And there's no autonomy involved. Whereas, with food and nutrients and nutritional psychiatry treatment plan, someone can say, “Well, I can, you know, drink enough water, and check off these boxes.” And that may seem minor, but people can be extremely anxious when they're dehydrated. They can feel quite unwell when they're not drinking enough water, especially if they're taking medications, and they have other health conditions.
They can almost latch onto three, two or three habits that they can start doing when they leave my office, that becomes quite powerful for them. And I find that those individuals tend to stick with the plan, compared to someone who wants 10 things that they can do. And I'll work with them to help them understand that that tends not to work.
Q: Yeah. So growing up in an Indian family, it sounds like you were taught at a young age about different flavors, different spices, different food in general. Do you find that culture and the diets of different cultures of the patients that you treat plays a role?
A: Absolutely. It's interesting, because the Mediterranean diet is often quoted. And it is actually one of the healthier ways to help people embrace, you know, a more broad-based, simple diet, which has healthy whole foods in it. And I was talking, I was teaching this at medical school class a few years back. And very appropriately, it was something I had been thinking about, because I experience this with my patients.
A student said, you know, “I don't understand how you can tell someone of a different culture to eat the Mediterranean diet. They've never eaten those types of food before.” I thought it was really an excellent point. So I picked on one ingredient, and I spoke about chickpeas. And I said, “You're absolutely right.” You know, whereas many different cultures may know what a salad is, and may know that, you know, these are healthier vegetables and those are not, there are many types of Indian dishes that are made with chickpeas. Is that a cultural link?
There are many types of other dishes that can—that chickpeas can be used for. And then, if you talk about how to integrate spices, and what someone likes to eat, but then if they tell you a dish that they like to eat, are you able to tell them how to lighten that dish, how to make it a healthier version? The cultural context, especially around spices, because spices have huge health value, and different ones.
And that also is almost a conversation starter with patients, by saying, “Well, you know, in your culture, what are the spices that you like to use?” And then picking up on what nutrient you can share with them, and say, “Well, can you add this to roasted vegetables, and use a little bit of, you know, avocado oil. And cook it in this way. And how can we integrate those spices?” Because they know that—But then you're also teaching them how to make healthy whole foods, instead of a processed frozen dinner that they heat up in the microwave. Can they start to do some simple things at home to healthier food?
Q: I love it. It feels so different than the way a lot of other, not to use the word diet, but diets talk about food, where it's like excluding certain things. It's all about integrating certain things.
A: Absolutely. It's all about adding things. And another thing that I try my best to not to do is demonizing ingredients, unless someone has an allergy. Like say they have celiac disease or non-celiac gluten sensitivity, they can't tolerate gluten. So that's different. But if someone can tolerate most ingredients, then you know, integrating healthy habits with those ingredients become important.
And I think that's the other thing that confuses people, exclude this. Don't eat soy. You know, don't eat this food or that food. What I'd rather do is say, if you can have dairy, try to get grass milk dairy. Because then, you know that the cows actually were raised in a particular way. And you get products now that are labeled, that people can understand that.
They are usually a little bit more costly. What I try to say to individuals is maybe spend a little bit more on that. Because if you are having dairy, you know that's a good source. And maybe for that we get less of something else to balance your budget. Because I know that these things can add up. But, you know, getting better quality eggs with omega-3, or pastured eggs becomes important if you eat eggs.
You know, whereas with vegetables. In the United States, vegetables are flash-frozen. So, unless there's a sauce or syrup or extra sodium or sugar, you know, pretty much that's a safe bet for you. And you can actually save a lot of money getting frozen vegetables if you need to, for a large family
Q: So throughout your journey with this, that gathering all of this knowledge, I imagine you've implemented it in your own life quite a bit. And I know you talk in your book a little bit about when you were diagnosed with cancer and undergoing treatment for that. Can you talk a little bit about how you sort of harnessed or used nutrition in food to manage that diagnosis?
A: It's interesting. Because at the time that I was diagnosed, I wasn't feeling unhealthy. Within about seven days, they discovered a lump, and was diagnosing me [00:41:52]. So, and you know, on the one hand, feeling best by having access to such amazing medical care. But, on the other hand, my emotional self hadn't caught up with my physical self. You know what I mean?
My body was having all of the tests done, and my emotions were still shocked at having discovered this lump by mistake.
So I had, you know, definitely been eating healthy, and you know, trying to practice what I was teaching my patients, and learning about myself. In the morning of my first treatment, I think what's very hard when you're a physician to be in the role of a patient, is that you actually know the medications, and you know the side effects. So it's the very same pharmacology that I had talked about with that very first patient, understanding side effects, also knew going into very intense chemotherapy.
So I was very anxious on the morning of my first treatment. I don't suffer with anxiety usually. And in the morning of my first treatment, I was having my morning cup of turmeric [?] tea, and, there's something in that moment that happened when the kettle shut off, that it's almost like a light switch went off in my head.
Because I thought, well, I'm all anxious about this treatment. But why am I not harnessing the one thing I know, which is I can't control the medications. I can't control the prescription pad of my doctor. But I can control what I'm eating, you know. So it's what I talk about. It's what I'm talking to patients about. So, from that moment, you know, how I ate, I kicked it up to a much higher level, really practiced what I was saying to my patients.
I went into it in a much deeper level, did more research, included more ingredients that made a difference to even managing my own anxiety, without medications. So that was an unexpected learning experience for me, and one which I wouldn't wish on anyone. But, at the same time, it was very meaningful for me, because I had to live the recommendations that I was giving to my patients, and really practice them on my own as well, beyond what I had been doing already.
Q: And has that changed anything for you, in sort of your clinical practice today?
A: Absolutely. You know, when you go through that form of treatment, I think that you are never the same person again. Not only when you go through the side effects and everything that happens. And I was very fortunate not to have suffered the level of side effects. And my doctors firmly believe that it was how I was eating. Because they would ask me, every single week, “What are you eating today? What have you been eating during the week? Because you are not having the nausea and the devastating side effects that other people experience.”
So I felt like it provided me the lens of having the empowerment to knowing how afraid I was of these chemotherapy medications, and what they could do to me, in terms of side effects, not the helping effects. And at the same time, this is how I could impact it, by how I'm eating and how I'm living in my lifestyle.
And I felt that that was an empowering message to share with individuals who were wanting to make changes, wondering how to go through it. And, as a psychiatrist, I don't necessarily, you know, share the fact that I had cancer with my patients. But I use them in how I speak to my patients about how to make changes, the moments that make a difference, you know, those moments when a light bulb goes off, and you realize, well, I can do something different.
Also, just having the experience and the lens of being so deeply immersed in a patient role, was very helpful for me, and understanding that it's not easy for people to make changes. And you know, never be judgmental about someone who's struggling to change their diet, because it's hard. It's really hard to give up those cookies. It's really hard to stop buying fast food, when that's what you're used to. Because that's what you know, and that's convenient for you.
Rather, find some empathy around what you can do to help them, and help educate them. Because when people understand what they can do differently, understand what they're doing and how it's impacting themselves, that's very, very powerful information.
Q: Thank you for sharing that story. I really appreciate that. Can you talk a little bit about, in your clinical work, sort of the different conditions where you've seen nutritional psychiatry really make an impact?
A: Especially in these times, I find that what's very significant in people are struggling with insomnia and immense amounts of stress and anxiety. And so I've really been calling it COVID anxiety, because it's so overwhelmingly intricately related to everything going on.
At the beginning of the pandemic, many people just turned to what they perceive to be comfort foods, that I think create discomfort for the brain. And processed foods, because people saw things like empty store shelves on television, and raced in to get foods that were shelf-stable, so they would have food for themselves and their families.
I think that just helping people unpack that, and understand that this is good time as any to start to maybe step back from those habits, and reset things that may have gone a little awry, and what can we do differently? What are the healthy habits that we can build in? What are the things they are eating that is driving anxiety?
And one such, two examples of that, actually, an individual who was using the pandemic in a healthy way, she really wanted to give up the high sugar she was eating in her food. So she switched to diet soda, very innocently thinking, I'm giving up all the sugar slowly. And I'm going to be much better off. But some of the artificial sweeteners were worsening her symptoms.
And, on the opposite end of that, I had individuals who are [00:48:56] in business. And they fly and travel most of the workweek. And they had been working on, you know, eating healthier, and you know, doing okay, in terms of their nutritional psychiatry treatment plans. But at least two of them had symptoms subside during the pandemic.
And it took me a while to figure out, when they realize they're eating all their meals at home. There was no takeout. There was no airport restaurant food. There was less alcohol, because they had fewer business meetings. And one of the biggest things was processed vegetable oils in foods that they were eating on the go, they were consuming that far less. Even if they weren't on any kind of special dietary plan, they were eating healthier foods at home.
And at least, at least two of them had a significant reduction in anxiety.
And I think with individuals who have mood symptoms, just starting to incorporate some basic building blocks of foods over time, that they didn't realize could actually make an impact, you know. There have been clinical trials that have looked at the comparison of an antidepressant versus the use of a probiotic.
So, you know, when people understand there's some information they can take from that, these foods become much more powerful tools for them to use.
Q: And so we've touched on it a little bit, and I just want to ask the question. But the way people talk about food, clean food, good food, bad food, junk food, how does that play a role in all of this? And how does that impact our relationship with food and our mental health?
A: So how we talk about food becomes important, because food is not a drug. It's not an addiction. And I'm not misspeaking about people who are truly struggling with, say, an eating disorder, or real addiction. Those are very real. And, of course, they need help. But, before they can come to a nutritional psychiatry plan, they do have to figure out that relationship with food.
So you know, I think talking about food in healthy terms, talking about it in positive terms, not demonizing foods, and just be pretty straight up with people and say, “Look. I know we call these foods comfort foods. But they're discomfort for your brain. So why don't we
rethink this. How can we do this better for you? How can you eat different types of food for the sweet tooth that you have, or that crispy salty snack that you want? How can we rethink it with a different recipe, a healthy, whole food?” And changing the conversation around food is part of what I'm doing with the individuals I work with.
Q: Yeah, wow. Can you talk a little bit about what you find, you know, most innovative, or most exciting, as far as research in the field?
A: Sure. You know, some of the most compelling research has been done around a few things. One has been inflammation and the role of inflammatory processes in now mental well being. So just very simply put, eating poorly, gut microbes are not well taken care of. The bad microbes take over the good microbes. And inflammation gets up in the gut.
Inflammation in the gut feeds back to inflammation in the brain. That makes mental health symptoms worse. That's one component. So there's immense amount of research around anti-inflammatory diets, around foods that cause inflammation, and therefore worsen mental health symptoms. Then there's a body of literature, really, the gut microbiome, different species of bacteria that are worse in certain conditions, helped by certain foods.
I mentioned leafy greens earlier. And then, there's a specific bacterial species that thrive under certain conditions. And these have been shown in studies. And there are many different areas of the research, but I find gut microbiome research to be compelling. The research around inflammation being a process of what's related or underlying some mental health issues right now.
And then I think the understanding of simple things, like the fact that a study showed that how we respond to sugar is not dissimilar to how we respond to a person who's using cocaine, because of the dopamine pathways, and how our brain reacts. So just understanding those background things help us understand our relationship to things like sugar. That all of those things have really been very compelling aspects of the research, which have helped to move this field forward.
Q: And just from a consumer perspective, it feels like there's quite a bit out there, making different claims about what food will make you feel good, what food won't make you feel good. So for listeners, how do you understand what's legitimate, when it comes to studies and research related to this field?
A: So I think finding well-vetted sources. In my book I decided to include many, many pages of end notes, which are the references. So that someone can look up the study, when I speak about a certain bacteria, you know, trying my best to make the book readable to anyone, so that they could learn from it. But the references are there for the science and the studies if they wish to look it up. I think that becomes important.
And people need to find sources of people who either write books, or even online sources that the information is well vetted. When you're looking at a study, it's hard for the average person to just go and look up a research study. But you know, even taking the study to your doctor, and asking him or her, you know, I've read about this. What does it mean? You can even do that in a virtual visit.
So you can find out information, and check it out with someone who would know. And I think that becomes important to empower ourselves about what we're reading about in the media, because if not we get taken by it, and, you know, sometimes they're missing parts in that information that I think people need to know for their own health.
Q: And you know, one thing you had mentioned when you were talking about your experience, the covering and going through cancer treatment, is that kind of mind-body awareness, that kind of you were aware of the moment when you didn't perhaps feel your best. And thought, oh, maybe I need to change something in my diet. Do you have advice for people who maybe have never practiced that in their own life, or maybe just advice in general on how to sort of get started on this journey of leveraging food for mental health?
A: Absolutely. I talk about something called body intelligence. And what I mean by that is, when you eat something, and you don't feel good, that is your body basically telling you that, for whatever reason, it doesn't agree with you. Now, if you have an allergy, that's different. But if you've eaten a meal, and every time you eat that meal, you feel exhausted, you want to lay down, you feel uncomfortable in your gut, you have a headache, you know, you wake up the next day and you don't feel good, or you have some, you know, GI symptom related to that, that is your body telling you something about that meal or that food or some ingredient.
And I think that becomes really important. So, for example, a lot of studies show that, you know, you can drink coffee. There's nothing wrong with coffee itself. But stay less than 400 milligrams a day, for a lot of mental health conditions, because if not, it starts driving anxiety, and make you feel uncomfortable. Some people may be able to consume more. But that's a good guideline, because it's not only based on some studies, it offers people some guidance around, we can have it, but just have it in moderation.
So I think paying attention to body intelligence becomes a focus. If you're an anxious person, and you get up in the morning, and you have a cup of coffee, and your heart starts to race, and you know, you feel your heart pounding, and your pulse is high, and you don't feel good, that is probably the coffee telling you that you don't agree with it. And it's worsening your anxiety.
So that becomes a very important starting point for people to hear what their body is actually saying. And it is not to make tweaks around that type of food, and start to embracing healthy habits. It could be that, say, a healthy plant-based food, like a lentil [?] is making you uncomfortable. That may not be that the lentil is specifically, that you're allergic or you have any reaction to it. It could just be that you have some underlying gut inflammation, from other things that you've been eating.
And maybe if you did some gut healing, by embracing a healthier diet, and those you know, prebiotics, probiotics, the good veggies, leafy greens, all of those foods we talked about earlier, maybe some gut healing would happen. And you know, a month later, you may be able to eat the same dish and be okay. But it's very, very personalized for each person. Because, you know, gut microbiome is like a thumbprint. So each person is quite unique and different.
So, you know, paying attention to the general principles around how food is making you feel becomes very important.
Q: Uma, this has been absolutely fascinating. Thank you so much for being part of the podcast.
A: Thank you for inviting me. I was very excited to be involved.
Q: Wonderful. Thank you. And then the last few questions we ask every guest. What's the best advice you've ever gotten?
A: The best advice I ever got was not food-related, but was from my mom. And my mom was a professor. And she was a double-boarded physician. And she actually was the person who pointed out—and I wasn't in an arranged marriage or anything like that. But she actually met my husband before I did. And she kind of drew my attention to him.
And I'm sure perhaps I would have met him somehow. But she happened to notice him in a class, and mentioned it to me.
And I think that that was really—her advice was golden, because you know, I think that she led me in the right direction. And I'm always grateful for that.
Q: What rituals help you have a successful day?
A: I try my best, on most days of the week, to do a meditation. And actually, even if it's on my phone, to write down things that I'm grateful for. And I always make the chai tea that I learned from my grandmother, golden chai is what it's called here, or what it's called in popular tea shops. But it's really turmeric, [01:09:12] and iced milk, and sometimes spices, and drizzled honey. But it's warming. It's how I start my day. And it's nourishing.
Q: Oh gosh. That sounds delicious. If you weren't a doctor, what would you be?
A: I would probably work as a professional chef in some form. And I would probably, maybe design really innovative foods that are fusion in nature, because I have a real love for spice. And now that I've understood more and more of the health benefits of spices, I feel that they can really bring cultures together, just by the element of fusion.
Q: What advice would you give your younger self?
A: I would probably say work less hard in the moment, and enjoy the moments more. Because I think I did many, many different areas of study. And to do that, I had to work very hard at those times. But sometimes you can slow down.
Q: What's the best decision you've ever made?
A: To go to culinary school. It was one of the things I really enjoy in my life. So I love being around food. And for me, learning about food in a different way, and so many different cultures, and different techniques, was very meaningful.
Q: What do you consider your super power to be?
A: My intuition. I've always had a very strong gut instinct. People always ask, “Well how did this come together in nutritional psychiatry?” And I really didn't have a plan. And I say that in a most sincere way. It came together, my intuitively following things that I loved to do.
Q: I love that, full circle. Thank you so much, Uma. It was such a pleasure having you on the podcast.
A: I loved speaking to you. Thank you so much, Kelsey. Thank you to the whole team for keeping us straight here, sounds. [laughter]
Charged is a podcast devoted to uncovering the stories of the women at Mass General who break boundaries and provide exceptional care.
Episode #51 of the Charged podcast
Episode #51 of the Charged podcast
Dr. Shenoy talks about what drove her to pursue a career in infection control, her unique experience of being a key leader and advisor in the hospital’s planning and response to the COVID-19 pandemic, what she and her team have learned since the first surge and how they are preparing for the future.
Episode #49 of the Charged podcast